Antolín Silvia, Acea Benigno, Albaina Luis, Concha Ángel, Santiago Paz, García-Caballero Tomás, Mosquera Joaquín J, Varela José Ramón, Soler Rafaela, Calvo Lourdes
Medical Oncology Department, Breast Unit, A Coruña University Hospital, A Coruña, Spain,
Surgery Department, Breast Unit, A Coruña University Hospital, A Coruña, Spain.
Breast Cancer (Dove Med Press). 2018 Dec 27;11:29-42. doi: 10.2147/BCTT.S179750. eCollection 2019.
The aim of this study was to evaluate the efficacy, cardiotoxicity profile and long-term benefits of neoadjuvant therapy in human epidermal growth factor receptor 2-positive operable breast cancer patients.
A total of 142 patients diagnosed from 2005 to 2016 were included in the study. The treatment consisted of a sequential regimen of taxanes and anthracyclines plus trastuzumab. The clinical and pathological responses were evaluated and correlated with clinical and biological factors. The cardiotoxicity profile and long-term benefits were analyzed.
The median age was 49 years, and 4%, 69% and 27% of patients had stage I, II and III breast cancer, respectively, while 10% had inflammatory breast cancer at diagnosis. Hormone receptor (HR) status was negative in 43%, and 62% had grade III breast cancer. The clinical complete response rate was 49% and 63% as assessed using ultrasound and magnetic resonance imaging, respectively, and this allowed a high rate of conservative surgery (66%). The pathological complete response (pCR) rate was 52%, and it was higher in HR-negative (64%) patients than in HR-positive (41%) patients and in grade III breast cancer (53%) patients than in grade I-II breast cancer (45%) patients. Patients who achieved pCR had longer disease-free survival and a trend toward improved overall survival. A total of 2% of patients showed a 10% decrease in left ventricular ejection fraction to <50% during treatment. All patients except one recovered after discontinuation of trastuzumab.
A sequential regimen of taxanes and anthracyclines plus trastuzumab was effective, with high pCR rates and long-term benefit, and had a very good cardiotoxicity profile.
本研究旨在评估新辅助治疗对人表皮生长因子受体2阳性可手术乳腺癌患者的疗效、心脏毒性特征及长期获益情况。
本研究纳入了2005年至2016年期间诊断的142例患者。治疗方案为紫杉烷类和蒽环类药物序贯治疗加曲妥珠单抗。评估临床和病理反应，并将其与临床及生物学因素相关联。分析心脏毒性特征及长期获益情况。
中位年龄为49岁，分别有4%、69%和27%的患者诊断时为Ⅰ期、Ⅱ期和Ⅲ期乳腺癌，10%为炎性乳腺癌。43%的患者激素受体（HR）状态为阴性，62%为Ⅲ级乳腺癌。超声和磁共振成像评估的临床完全缓解率分别为49%和63%，这使得保乳手术率较高（66%）。病理完全缓解（pCR）率为52%，HR阴性（64%）患者高于HR阳性（41%）患者，Ⅲ级乳腺癌（53%）患者高于Ⅰ - Ⅱ级乳腺癌（45%）患者。达到pCR的患者无病生存期更长，总生存期有改善趋势。共有2%的患者在治疗期间左心室射血分数下降10%至<50%。除1例患者外，所有患者在停用曲妥珠单抗后均恢复。
紫杉烷类和蒽环类药物序贯治疗加曲妥珠单抗有效，pCR率高且有长期获益，心脏毒性特征良好。
